Utilization of eight antenatal care contacts among adolescent and adult women at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

Abstract

Early antenatal care booking and compliance with eight antenatal care contacts improve positive pregnancy experiences and outcomes. In 2022, Kenya adopted the World Health Organization recommendation for eight antenatal care contacts. According to the Kenya Demographic and Health Survey 2022, 29% of women booked early for antenatal care, but only 4% completed all eight antenatal care contacts. Although the new model offers clear benefits, maintaining adherence remains difficult, as both adolescent and adult women encounter significant barriers to initiating early and completing the eight contacts. Factors influencing the timely initiation and frequency of the eight antenatal care contacts were investigated among adolescent and adult women at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. A comparative cross-sectional analytical study was conducted, and the theoretical framework was guided by Andersen and Newman’s Behavioural Model for Health Services Utilization. The conceptual framework was constructed using variables from the literature review and the World Health Organization’s 2016 recommendations for antenatal care. All women admitted to the maternity department were used as the target population. Stratified random sampling was used to recruit 73 adolescent and 219 adult women in a 1:3 ratio, resulting in a sample of 292 women, calculated using a formula for two proportions. Data was collected using a questionnaire and the antenatal booklet. Informed consent and data confidentiality were ensured. Data analysis was conducted using the Statistical Package for the Social Sciences version 26. Descriptive statistics were used for predisposing, enabling, and need factors. The Mann-Whitney U test and the chi-square test were used to compare the timing of the first antenatal care contact and the frequency of recommended antenatal care contacts between adolescent and adult women. To identify associated factors, multivariable logistic regression was used. The median and mean ages for adolescent women were 18.0 and 17.82 ± 1.14 years, respectively, and for adult women, 29.0 and 27.69 ± 4.68 years, respectively. Adult women had higher rates of marriage, urban residence, health insurance coverage, and autonomy in antenatal care decision making than adolescent women (p<0.05). Both adult and adolescent women booked antenatal care late, with a median of 18.00 weeks IQR 10-22 compared with 20.00 weeks IQR 12-24 (p = .02). Both adult and adolescent women had fewer than eight antenatal care contacts, with a median of 5 (IQR 3-6.5), compared to 4 (IQR 3-5.5) (p = .04). Only 10.5% of adult women completed eight antenatal care contacts compared with 8.2% of adolescent women. Early antenatal care booking was influenced by receiving antenatal care information from healthcare providers (AOR = 1.96; 95% CI [ 1.06, 3.71], p = .036). Women with high-risk pregnancies (AOR = 2.33, 95% CI [1.47, 3.91], p = .005) had more antenatal care contacts than those with low- or moderate-risk pregnancies. This study highlights a major challenge in achieving early antenatal care booking and completing eight antenatal contacts among adolescent and adult women. To improve antenatal care attendance at JOOTRH, we recommend expanding access to services for adolescent and adult women to address widespread late bookings. Building on the positive influence of healthcare provider education and countering misinformation from informal networks, providers should actively participate in community outreach programs. The facility should also establish routine tracking systems and arrange follow-ups by community health workers to sustain engagement and prevent high dropout rates. Finally, Women with low- or moderate-risk pregnancies should be encouraged to complete all eight scheduled contacts for preventive care, even if they have no active physical symptoms.